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General NPI Number Information
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NPI Number | 1619613031
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Entity Type | Organization
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Legal Business Name | RESONATE INDIVIDUAL AND FAMILY THERAPY
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 10368 DONNER PASS RD
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City | TRUCKEE
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State | CA
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Zip | 96161-0427
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Country | US
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Telephone | 925-658-8367
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Fax |
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Provider Business Mailing Address
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Address Line | 12401 GREEN PASTURE DR
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City | TRUCKEE
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State | CA
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Zip | 96161-2916
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Country | US
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Telephone | 925-658-8367
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MICHELLE VANDERJAGT
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Credential | LMFT
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Telephone | 760-410-8096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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